Noninvasive Imaging Techniques as Modern Diagnostic Tools in Desquamative Gingivitis: Focus on RCM, OCT, and LC-OCT.

backgroundDesquamative gingivitis is a clinical condition characterized by erythema, blisters, and erosions within the gingiva. It may be a manifestation of oral lichen planus or autoimmune bullous diseases, such as pemphigus vulgaris and mucous membrane pemphigoid. The identification of the cause of desquamative gingivitis typically involves the analysis of clinical manifestations, histopathology, and immunopathology evaluation. This article reviews available data on the application of noninvasive imaging techniques (reflectance confocal microscopy, optical coherence tomography, and line-field confocal optical coherence tomography) in identifying the cause of desquamative gingivitis. MATERIALS AND

methodsThe review of the literature for desquamative gingivitis was performed by searching the PubMed, Scopus, and Wiley databases up to January 2025.

resultsThis study aimed to evaluate the applicability of noninvasive imaging techniques, including RCM, OCT, and LC-OCT, in the differential diagnosis of desquamative gingivitis. Findings suggest these modalities offer characteristic diagnostic patterns across underlying diseases. In oral lichen planus, RCM typically shows disrupted connective tissue papillae, obscured basement membranes, and inflammatory cell infiltrates. In pemphigus vulgaris, the key findings are acantholytic keratinocytes and intraepithelial clefts, while mucous membrane pemphigoid displays subepithelial clefts and signs of hemorrhage. OCT findings in desquamative gingivitis associated with oral lichen planus include maintained epithelial thickness in the erosive forms and multilocular blisters in the bullous variants of the disease. In pemphigus vulgaris, OCT reveals intraepithelial clefts and thinning of the epithelium, while mucous membrane pemphigoid is marked by subepithelial blister formation and fluid accumulation.

conclusionNew noninvasive imaging techniques, such as reflectance confocal microscopy and optical coherence tomography, may support clinical decision-making, improve biopsy targeting, and enhance long-term monitoring of desquamative gingivitis.